Provider Demographics
NPI:1548367337
Name:MAYO, ROGER D (LDO)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:D
Last Name:MAYO
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6940 LEE HWY
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2490
Mailing Address - Country:US
Mailing Address - Phone:423-892-4900
Mailing Address - Fax:423-855-1496
Practice Address - Street 1:6940 LEE HWY
Practice Address - Street 2:SUITE 108
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2490
Practice Address - Country:US
Practice Address - Phone:423-892-4900
Practice Address - Fax:423-855-1496
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN409156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2001691OtherBLUE CROSS BLUE SHIELD TN